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Need a second opinion (Read 2971 times)
zac1852
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Heart Palpitations
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Need a second opinion
Feb 21st, 2013, 5:38pm
 
Hi all,

My name is Zac and I am 25 years old. At age 14 I was diagnosed with SVNRT and had a successful ablation done at the U of Penn Hospital. Since then I have suffered with severe health anxiety that has unfortunately gotten worse over the years. I do have good periods but also have very bad times as well where I convince myself I am dying.

Lately I have been having one of those bad periods. Last summer I ended up in the ER because I was experiencing heart flutters. They were able to catch 1 pvc on the EKG but found nothing else wrong with me or my heart. I followed up with my local cardiologist who offered to do an echo and 24 hour holter to put my mind at ease. The echo came back perfect and the holter showed 1 premature ectopic beat and 1 premature supraventricular beat. The cardiologist confirmed that everything was perfectly normal.

Up until last week I would only experience a random pvc here and there. Last Monday night I started getting big thumps in my chest about every 5 minutes and I began to panic. Since then they havent stopped. Some times are worse than others but I get them all times of the day. I finally decided that this past Tuesday night that I would go to the ER to get checked out. The doctor there ran all different types of blood tests, ekg and a chest xray. Everything came back perfect and the only thing he said he saw was palpitations. He explained to me that he didnt see any skips or pauses though.

So my question is can you have random palpitations where there are no skips or pauses present and can stress/anxiety be the reason for experiencing them. What else had me concerned was that everytime i would get a palpitation the heart monitor would show my heart rate drop about 10bpm but would then go back up after a few seconds. I feel like my resting heart rate has dropped quite a bit over the year as well. Lately it has been around 62bpm. I am currently 5'8" 157 lbs. I worked a desk for the past 3 years and really dug myself into a hole with eating bad, not ever getting up from my chair or exercising and dealing with tons of daily stress.

November of 2012 I started a more strenous job and it hasnt been easy getting back into shape and losing a lot of weight. I feel like my blood pressure is high but my family doctor claims the readings he gets are always perfect. I take it at home regulary and my first reading will usually be high like 150/90 but if i sit and relax for 5 mins it will usually come down to 130/75ish.

You would think I would feel good and be reassured with all the doctors and tests i have been through however it is hard for me to live anxiety free with these annoying palpitations. I have noticed that when i can take my mind off of them that they almost completely dissapear. I hope someone on this forum can put my mind at ease and tell me im being silly. I have a wife and 2 kids who are counting on me to get better.

Thanks so much,

Zac
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RLR
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Re: Need a second opinion
Reply #1 - Feb 22nd, 2013, 5:25pm
 
Firstly, let me just preface any remarks by sharing with you that this forum exists to provide medical information rather than medical advice. Although I am a retired physician, it is important for you to recognize that "second opinions" are strictly obtained within the practicing medical community and should not be sought through online sources.

Having made the statement, I'll also share here that you and your family can all relax. You're going to be just fine and you're in no danger whatsoever. The specific type of palpitation events that you are experiencing are arising from outside the heart, not from within. In persons under significant stress and/or anxiety, the central nervous system is chronically stimulated and this increases the opportunity for wayward evoked potentials, or nerve impulses, to be generated in a manner that is uncharacteristic.

In the case of benign heart palpitations, they actually arise along the pathway of the vagus nerve, one of the terminal endings of which happens to be the heart. Remember that your heart muscle is as much a muscle as it is an organ and like other muscle groups in the body, the heart's tissues will respond to electrical activity whether by the normal course of the heart's sinus pacers or whether extracardiac in nature, or in other words from a source outside the heart.

These specific palpitations are more akin to a simple muscle twitch than any type of cardiac arrhythmia. Furthermore, because of this origin, they are entirely incapable of inducing any type of cardiac event or transforming your heart's rhythm into some type of dangerous arrhythmia. Just as any eyelid muscle responds to a wayward impulse in the characteristic manner that most people have experienced from time to time, so it is with the heart muscle. It is only because of the stressed importance of the heart's function that people become influenced so quickly by irrational fears concerning the palpitation events. It is the fear of a perceived outcome that frightens persons experiencing the palpitations.

GI disturbances can also increase the potential for vagus nerve-induced palpitations to occur and this is because the vagus nerve innervates the GI tract as the pneumogastric nerve at that level. Realize that conditions as simple as excess gas which produces bloating can be sufficient enough to apply upward pressure against the diaphragmatic muscle and resulting in the increased potential for palpitations to subsequently manifest. A reduction in GI symptoms will quickly correspond to commensurate reduction in palpitation frequency and intensity.

You're going to be just fine and you're in no danger whatsoever. It should interest you to know that throughout medical history, there is not one recorded case of an individual coming to even the slightest harm as a consequence of palpitation events of the type you are experiencing. Not a single case.

Best regards,

Rutheford Rane, MD (ret.)
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Best Regards and Good Health
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